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In vaginismus, the pelvic floor muscles go into painful involuntary spasm and reduce the size of the vaginal opening. As a result, sexual intercourse may be very painful and vaginal penetration can often be impossible. The condition varies in severity for different women. Some women are affected by vaginismus to such an extent that they cannot insert even a finger or a tampon into the vagina and may need an anaesthetic for a vaginal examination. Other women may be able to tolerate a vaginal examination by a doctor or nurse but cannot tolerate sexual intercourse.

What are the causes?

Vaginismus is usually psychological in origin and often occurs in women who fear that penetration may be painful. This fear may result from a previous traumatic sexual experience, such as a rape or sexual abuse in childhood. Another cause of vaginismus may be the fear of pregnancy. Anxiety or guilt concerning sex may also be a contributing factor to this condition.

Certain physical disorders can also lead to vaginismus. Inflammation of the vagina may make intercourse painful and lead to vaginismus. Some women develop the condition because they expect that sex will be painful after childbirth or that they will experience sexual difficulties during or after the menopause.

What might be done?
Your doctor will examine you gently to look for any physical problem that could make penetration painful or difficult. If there is an underlying physical cause, he or she will treat it. If the problem is psychological, you may need some form of psychological therapy or, alternatively, you may be referred to a sex therapist. The sex therapist will explain that the vaginal wall is elastic and may teach you relaxation exercises. He or she may then show you how a small dilator can be inserted into the vagina. By practising this technique and gradually using larger dilators, you should lose your fear that penetration will be painful. Treatment for vaginismus is successful in about 9 out of 10 women.